Factors affecting in-hospital mortality after reoperations for blast traumatic brain injuries

Background. The proportion of combatants with severe traumatic brain injury (TBI) transferred from Role 3 to Role 5 with postoperative complications requiring repeated surgery is as high as 86%. Repeated surgical interventions increase the length of hospital stay and affect treatment outcomes. Currently, there is a lack of data on in-hospital postoperative mortality in cases of blast TBI, as well as a gap in knowledge regarding the factors that influence it.
Purpose: to analyze the factors influencing in-hospital mortality of combatants after reoperations for blast TBI.
Material and methods. A single-center retrospective study was conducted of 22 cases of in-hospital mortality among male combatants in a cohort of 125 patients who underwent reoperation for blast TBI and were treated at the A.A. Vishnevsky National Medical Research Center for High Medical Technologies in 2023–2024. The following inclusion criteria were used: age 20-50 years, blast TBI, severe TBI being the leading injury, combined non-penetrating combat trauma of other localization. Statistical analysis was performed using R 4.5.0 (The R Foundation, Austria).
Results. Factors influencing in-hospital mortality after repeated surgery for blast TBI were identified. Age over 30 years was associated with a rate of increase in the risk of death after reoperation of 1.82 [95% CI: 0.66; 5.01] times. The diametric wound tract was associated with increased rate of risk of an unfavorable outcome after reoperation of 2.89 [95% CI: 1.4; 5.97] times (p = 0.009). Statistically significant (p<0.001) predictors of death after reoperation according to axial computed tomography data were midline shift more than 5 mm (OR=11.6 [95% CI: 4.21; 31.8]) and presence of subdural hematoma (OR=5.48 [95% CI: 2.99; 10.1]). A statistically significant association was noted between risk of death and the Glasgow Coma Scale score upon hospital admission (p=0.01): a decrease in the incidence of death with an increase in the score on the scale (p=0.003). Decompressive craniectomy was associated with a 3.09-fold increase (95% CI 0.97–9.85] (p=0.045), and drainage of cerebrospinal fluid spaces was associated with a 5.88-fold increase in the risk of death (95% CI 2.49–13.9] (p<0.001). Craniectomy was associated with a reduced risk of death after reoperation (p=0.024). Conclusion. Our results will contribute to the systematization of data that facilitate correct clinical decision-making and support development of standards in medical care for reoperations in combatants with severe TBI.
Keywords: reoperation, combat wounds, liquorrhea, craniectomy, infectious complications, traumatic brain injury, TBI
Conflict of interest. The authors declare that there is no conflict of interest.
Funding. This research received no specific grant from any funding agency in the public, commercial, or not-forprofit sectors.